Attch 1_20250624 PWS Audiogram Svcs.pdf

PERFORMANCE WORK STATEMENT

FOR

AIR FORCE RESERVE COMMAND

CIVILIAN AUDIOLOGICAL EVALUATION

1.0 DESCRIPTION OF SERVICES.

1.1 Scope. Provide full comprehensive audiometric testing sufficient to determine type and degree of hearing loss.

1.2 Organization. The AFRC organization with primary responsibility for this requirement is 934th Aeromedical Staging Squadron (ASTS).

1.3 Place of Performance. The performance shall be at the 934th Airlift Wing, Minnesota Air Force Reserve, Bldg. 840. The 934th ASTS representatives and the Contractor shall jointly establish mutually acceptable dates for the services being scheduled, within a 180-day time frame.

1.3.1 Hours and Dates. Unless otherwise approved by the CO/COR, the contractor shall provide services between the hours of 0600-2300, Monday through Thursday, 0600-1800 Friday, and 0600-1600 UTA weekends, except on recognized US holidays.

1.4 Required Services. Provide full comprehensive audiometric testing sufficient to determine type and degree of hearing loss. The contractor, with exception of Government furnished items and services listed in paragraph 3, shall provide all personnel, equipment, tools, materials, supervision and other necessary items to perform these functions, in accordance with the terms and conditions specified within this Performance Work Statement (PWS).

1.4.1 Qualifications. The Contractor must be able to provide audiology evaluations by an audiologist with an active license.

1.4.2 Materials. Diagnostic audiometry equipment sufficient to complete the following required hearing examinations to include but not limited to:

1.4.2.1 Pure tone air conduction test, under supra-aural earphones or insert earphones, using pulsed tones for frequencies 250 Hz through 8,000 Hz (to include 3,000 and 6,000 Hz).

1.4.2.2 Pure tone bone conduction test, using pulsed tones for frequencies 500 through 4,000 Hz (to include 3,000 Hz).

1.4.2.3 Word recognition testing, under supra-aural earphones or insert earphones, using electronically recorded lists presented at appropriate suprathreshold levels.

1.4.2.4 Word testing using competing background noise if the patient reports difficulty hearing/understanding in the presence of background noise.

1.4.2.5 Immittance measures to include tympanometry, and acoustic reflexes obtained for both ipsilateral and contralateral conditions.

1.4.2.6 Acoustic reflex decay at 500-1,000 Hz should be accomplished if clinically warranted.

1.4.2.7 All tests are to be performed unaided and with equipment calibrated per the most current and applicable American National Standards Institute (ANSI) standards.

1.4.2.8 Proof of acceptable background sound pressure levels measured in the audiometric test room. Note: This is required for network audiologists.

1.4.2.9 Proof of current audiometer calibration. Note: This is required for network audiologists.

1.4.2.10 Otoacoustic Emissions testing.

1.4.3 Submittals.

1.4.3.1 The Contractor shall provide audiology reports to the 934th Aeromedical Staging Squadron (ASTS) which will include recommendations for hearing aids, hearing protection, further medical referral, and include noise exposure history, any known indicators to the cause of hearing loss, and an interpretation of test results to explain the type and degree of hearing loss.

1.4.3.2 No later than one week after completion of examination, contractor shall submit the audiology report to the 934th ASTS by fax 612-726-9330.

1.4.4 Miscellaneous Requirements and Details.

1.4.4.1 It is the patient’s responsibility to ensure their ears are clear of compacted ear wax.

The 934th Aeromedical Staging Squadron will not pay for the patient’s ears to be cleaned.

a. The 934th ASTS has directed patients to have their ears examined by appropriate 934th ASTS staff prior to scheduling their appointment.

b. In the event their ears are compacted, patients will be advised to see their primary care provider to clear their ears or to buy a home kit and do it themselves.

c. In the event the patient arrives at their scheduled appointment and is noted to have compacted ears, the patient is to be turned away and told to reschedule the appointment once their ears have been cleaned. The 934th Aeromedical Staging Squadron will not be charged unless the audiogram testing is completed.

1.4.4.2 The 934th Aeromedical Staging Squadron reserves the right to postpone, cancel, or reschedule a scheduled appointment, if necessary, due to unexpected mission restrictions, or patient emergency (i.e., car accident, family death, ordered military duty).

a. The 934th ASTS will adhere to a 48-hour notification window when the postponement, cancelation, or reschedule does not involve an emergency.

1.4.4.3 Contractor will communicate with the 934th ASTS representative(s) in the event of the following:

a. Any changes to the cost of examination(s)

b. Changes to scheduling and availability for examinations Monday-Friday

c. Patient no-shows

d. Desire to end the agreement

2.0 SERVICES SUMMARY (SS). The Government will evaluate the Contractor performance in accordance with the following criteria. Performance evaluations will be rendered in one or more Government databases for that purpose.

PWS

Par.

Number Performance Objective Performance

Threshold

Frequency Responsibility

1.4 and 1.4.2

Provide full comprehensive audiometric testing

Exams completed 95% of the time of initial scheduled time.

Per Call COR

1.4.3.1 and 1.4.3.2

Audiology report of exam results/recommendations submitted to 934th ASTS within one week of exam completion

Audiology report provided within one week 95% of the time.

Upon completion of each testing

COR

3.0 GOVERNMENT PROPERTY AND SERVICES

3.1 Base Support. The Government shall furnish items incidental to the place of performance (Ex:

electricity, water, office space, etc.) The contractor shall ensure use is limited to performance of contract related official Government business. Upon completion or termination of the contract or expiration of employee identification passes, the prime contractor shall ensure that all items are returned to the Contracting Officer’s Representative (COR).

3.2 Government System(s). Access to Government systems will not be required to perform tasks under the Blanket Purchase Agreement (BPA).

4.0 GENERAL REQUIREMENTS

4.1 Recognized Holidays. The following are recognized United States (US) holidays. The contractor shall not perform services on the listed Federal holidays unless otherwise waived by the CO or COR.

FEDERAL HOLIDAYS

New Year’s Day, January 1, Friday preceding or the Monday following Martin Luther King’s Birthday, 3rd Monday in January President’s Day, 3rd Monday in February Memorial Day, Last Monday in May Juneteenth, June 19th, Friday preceding or Monday following Independence Day, July 4, Friday preceding or Monday following Labor Day, First Monday in September Columbus Day, 2nd Monday in October Veteran’s Day, November 11 Thanksgiving Day, 4th Thursday in November Christmas Day, December 25, Friday preceding or Monday following

4.2 Quality Control (QC). The Contractor shall develop and maintain an effective quality control plan (QCP) to ensure services performed are in accordance with this PWS and all laws and government regulations. The Contractor shall develop and implement procedures to identify, prevent, and ensure the non-recurrence of defective services. The Contractor’s QCP is the means by which it assures itself that its work complies with the requirements of the contract. As a minimum, the contractor shall develop QC procedures that address the areas identified in paragraph 2, Services Summary.

4.3 Quality Assurance (QA). The government will periodically evaluate the contractor’s performance in accordance with the Service Summary. This plan is primarily focused on what the Government will do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and acceptable quality level(s) or defect rate(s)

4.4 Contract Manager (CM). The contactor shall designate a CM who shall ensure performance under this contract. The name of this person, and an alternate who shall act for the contractor when the CM is absent, shall be designated in writing to the CO within five days upon BPA Award. The CM or alternate shall have full authority to act for the contractor on all contract matters relating to the daily operation of this contract. The CM shall work through the COR, or the CO if no COR is assigned, to resolve issues, receive technical instructions, and ensure adequate performance of services. The CM shall ensure that contractor employees do not perform any services outside the scope of the contract without an official modification issued by the CO. The CM shall ensure contractor employees understand that services performed outside the scope of the contract are performed wholly at the expense of the contractor.

4.5 Non-personal Services. The Government will neither supervise contractor personnel nor control the method by which the contractor performs the required tasks. Under no circumstances shall the Government assign tasks to, or prepare work schedules for, individual contractor personnel. It shall be the responsibility of the Contractor to manage its personnel and to guard against any actions that are of the nature of personal services or give the perception of personal services. The Contractor shall notify the 934th CO immediately if any task requires action by the Contractor personnel that constitutes or are perceived to constitute personal services. These services shall not be used to perform the work of a policy/decision making or management nature, i.e. inherently governmental functions.

4.6 Security. The Contractor shall comply with all security regulations and directives identified herein and other security requirements as shown elsewhere in this contract.

4.7 Controlled Unclassified Information. The Contractor shall mark, handle and safeguard Controlled Unclassified Information in accordance with the DoD Manual 5200.1-M, Volume 4, DoD Information Security Program: Controlled Unclassified Information (CUI).

4.8 Physical Security Program.

4.8.1 Installation Perimeter Access Control. The requirements for installation perimeter access are detailed in the Air Force Federal Acquisition Regulation Supplement (AFFARS) clause 5352.242-9000 entitled, Contractor Access to Air Force Installations, in Section I, Contract Clauses, of the basic contract. Contractors merely requiring unescorted access to the installation to perform services, that don’t require access to classified information or network access, will be vetted IAW AFM 31-113, para 4.3 and issued a DBIDS identification Card. The Contractor is only allowed to visit the installations specified in the contract.

4.8.2 Resource Protection and Integrated Defense. The Contractor shall safeguard all government property in accordance with AFI 31-101, Integrated Defense, and any forms provided for Contractor use. The Contractor shall immediately report all thefts, vandalism, or destruction of property and equipment (Government or Contractor owned)

4.9 Physical Security Program.

4.9.1 Privacy Act of 1974. The Contractor personnel shall have access to Privacy Act information that requires adherence with the Privacy Act of 1974, Title 5 of the U.S. Code, Section 552a, AFI 33-332, Air Force Privacy Act Program, and other applicable agency rules and regulations. The Contractor personnel shall follow agency procedures to identify and safeguard reports and data accordingly. The Contractor shall ensure that Contractor personnel assigned to this requirement are briefed annually on properly identifying and handling Privacy Act data and reports.

4.17 Trafficking in Persons: The Contractor shall comply in accordance with the FAR and applicable supplements and shall be in compliance with all applicable guidance and clauses listed in the contract as it relates to Trafficking in Persons. Additional information about Trafficking in Persons is available at the site for the Department of State’s Office to Monitor and Combat Trafficking in Persons. http://www.state.gov/j/tip.

5.0 APPENDICES

Appendix A, Deliverables

Type of Deliverable

Format/Medium Number of Copies

Due Date Recipient(s)

Audiologist License

1 Electronic Copy At Quote CO

Identify Contract Manager (CM)

In Writing Not later than 5 calendar days after award

COR or CO http://www.state.gov/j/tip